The purpose of this project is to assess the effect of current dysphagia management techniques on medical complications and ADL-mobility rehabilitation outcome following stroke. The basic hypothesis is that optimum management of fluid intake, nutritional support, and airway protection should obviate many of the problems which plague rehabilitation efforts: Dehydration, inanition, aspiration pneumonia, death, and poor recovery of self-care and mobility function following stroke. The study de- sign is an open step-care protocol with each step representing a greater level of therapist control of diet consistency and reinforcement of compensatory swallowing techniques. A control population without any diet modification is judged to be unethical. Three different levels of dysphagia care will be studied for patients deemed to be "low risk patients". Two levels of dysphagia therapy intervention will be available for patients deemed to be "high risk patients". The independent variable therefore will be the level of dysphagia care provided for patients stratified into either high or low risk categories. Dependent variables will assess the following: state of hydration (serum electrolytes, blood urea nitrogen (BUN), BUN to creatinine ratio, and urine specific gravity); calorie-nitrogen balance (body weight, serum albumin, and ketonuria without glycosuria); medical complications (pneumonia, pressure sore, other medical problems significant enough to require specific therapy); death; and rehabilitation outcome (serial Barthel ADL-mobility scores). The spectrum of treatment interventions provided by this protocol is an attempt to validate differ- ences due to the intensity of dysphagia therapist intervention. Such outcome data are essential for defining the optimum level of dysphagia care and would have major national and international health care repercussions. This study is unique. There has been no previously published prospective randomized controlled trial of any dysphagia therapy technique or diet modification on the subsequent development of pneumonia, dehydration, weight loss, death, or final ADL functional outcome following stroke.